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Care Transition Manager

1 month ago

Dallas, Texas, United States Texas Health Resources Full time
Care Transition Manager Job Description

We are seeking a highly skilled Care Transition Manager to join our team at Texas Health Dallas. As a Care Transition Manager, you will play a critical role in ensuring patients are transitioned to appropriate levels of care in a timely and effective manner.

Key Responsibilities:
  • Review Texas Health Readmission Indicator List (THRIL) scores daily for all assigned patients
  • Identify high-risk patients and promote discussion to identify a primary care physician (PCP)
  • Complete Transition Evaluations on patients within 24 hours of identification and begin discharge planning
  • Interview and assess patients and caregivers as part of the transition evaluation
  • Identify transition needs and discuss funding of post-transition care with patients and caregivers
Requirements:
  • Master's Degree in Social Work required
  • Three years of experience in hospital/medical social work preferred
  • One year of experience in discharge planning/care management
  • Licensed Master Social Worker (LMSW) or Licensed Clinical Social Worker (LCSW) upon hire required
Benefits:
  • 401k, PTO, medical, dental, Paid Parental Leave, flex spending, tuition reimbursement, student Loan forgiveness, and several other benefits
  • Delivery of high-quality patient care through nursing education, nursing research, and innovations in nursing practice
  • Strong Unit-Based Council (UBC)
  • A supportive, team environment with outstanding opportunities for growth